Submitted by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T16:56:35Z No. of bitstreams: 1 Dissertação Flávia Matos.pdf: 868333 bytes, checksum: 75207be4679ddfd22055131d0846333d (MD5) / Approved for entry into archive by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T16:57:10Z (GMT) No. of bitstreams: 1 Dissertação Flávia Matos.pdf: 868333 bytes, checksum: 75207be4679ddfd22055131d0846333d (MD5) / Approved for entry into archive by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T16:58:19Z (GMT) No. of bitstreams: 1 Dissertação Flávia Matos.pdf: 868333 bytes, checksum: 75207be4679ddfd22055131d0846333d (MD5) / Made available in DSpace on 2018-07-31T16:58:49Z (GMT). No. of bitstreams: 1 Dissertação Flávia Matos.pdf: 868333 bytes, checksum: 75207be4679ddfd22055131d0846333d (MD5) Previous issue date: 2018-02-26 / Although the objective structured clinical examination (OSCE) is considered golden standard for the assessment of clinical skills, the exam is both expensive and complex. On the other hand, structured oral examinations (SOE) have much simpler application and lower cost. Nonetheless, SOE may have lower validity and reliability. Objective: To compare Medical students’ academic performance and perception in regard of assessing skills through OSCE and SOE. Method: Two tests were designed (OSCE and SOE) to evaluate five obstetrical skills in a mannequin (the first three Leopold maneuvers, fundal height measurement, and fetal heart rate auscultation). The SOE assessed skills separately and the OSCE evaluated the skills after the analysis of a contextualized case. Students of the 4th term of Medical School were distributed into two groups. In the first phase of the study, Group 1 performed SOE, and Group 2, OSCE. Three weeks later, in the second phase, the same tests were applied inversely. Tests were applied by the same teacher, who employed the same checklist in both tests. In the second phase, a survey about students’ perception towards both test types was also applied. The mean score in each question was compared, as well as the final score, concerning the following crossings: test type in each of the two phases; test type regardless of phase; intragroup OSCE and SOE, and scores of the first and second stages, regardless of test type, as well as between groups, regardless of phase. Students’ perception was analyzed according to frequency distribution and grouping of open-ended answers by similarity. Results: 21 students participated in the study: 13 in Group 1, and 8 in Group 2. No difference was found in all the other crossings, except for the scores between phases. As for the intragroup comparison, the final score and the question 2 (fundal height measurement) score were superior in the second phase in both groups. The comparison between mean scores of the first and second phases, regardless of test type, demonstrated that the scores of the second phase were superior in the final score and in all questions, except for the second and third Leopold maneuvers. The scores’ improvement on the second day may be related to the testing effect. Conclusion: the test type did not influence students’ performance. Most candidates preferred the OSCE type. / Apesar do exame clínico objetivo estruturado (OSCE) ser considerado padrão ouro para avaliação de habilidades clínicas, ele é uma prova de organização complexa e de alto custo. Por outro lado, as provas do tipo prática-oral estruturada (POE) são de aplicação mais simples e de menor custo, ainda que possam apresentar menor validade e confiabilidade. Objetivo: comparar o desempenho acadêmico e a percepção de alunos de Medicina na avaliação de habilidades por OSCE e POE. Método: foram elaboradas duas provas (OSCE e POE) para avaliação de cinco habilidades obstétricas em manequim (três primeiras manobras de Leopold, medida de útero-fita e ausculta de batimentos cardíacos fetais). A POE avaliou as habilidades isoladamente e o OSCE avaliou as habilidades após a análise de um caso clínico contextualizado. Estudantes do 4º período do curso de Medicina foram distribuídos em dois grupos. Na primeira fase, o Grupo 1 realizou a POE e o Grupo 2 o OSCE. Na segunda fase, 3 semanas após, aplicou-se novamente as mesmas provas, de modo invertido. As provas foram aplicadas por um único avaliador, que utilizou o mesmo checklist nas duas provas. Na segunda fase, aplicou-se também um questionário sobre a percepção dos alunos em relação aos dois tipos de prova. Comparou-se a nota média em cada questão e a nota total nos seguintes cruzamentos: tipo de prova em cada uma das fases; tipo de prova independentemente da fase; OSCE e POE intragrupo e notas da primeira e da segunda fases, independentemente do tipo de prova, bem como entre os grupos, independentemente da fase. A percepção do aluno foi analisada por distribuição de frequência e agrupamento das respostas abertas por semelhança. Resultados: 21 alunos participaram do estudo, sendo 13 do Grupo 1 e oito do Grupo 2. Não houve diferença entre as notas das questões e a nota total, entre os dois tipos de prova, nas duas fases do estudo. Também não se observou diferenças em todos os outros cruzamentos, exceto quando se comparou as notas entre as fases do estudo. Na comparação intragrupo, a nota total e a nota da questão 2 (útero-fita) foi superior na segunda fase nos dois grupos. A comparação entre as médias das notas na primeira fase e na segunda fase, independentemente do tipo de prova, demonstrou que as notas da segunda fase foram superiores na nota total e em todas as questões, exceto na 2ª e 3ª manobras de Leopold. A melhora das notas, no segundo dia, pode estar relacionada ao efeito teste. Conclusão: o tipo de prova não influenciou o desempenho do aluno. A maioria dos alunos preferiu a prova tipo OSCE.

Submitted by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T18:14:09Z No. of bitstreams: 1 Dissertação Edson Dell Amore Filho.pdf: 708297 bytes, checksum: d624f6ac7e0eb9fcbdcd4058c5e05da6 (MD5) / Made available in DSpace on 2018-07-31T18:14:09Z (GMT). No. of bitstreams: 1 Dissertação Edson Dell Amore Filho.pdf: 708297 bytes, checksum: d624f6ac7e0eb9fcbdcd4058c5e05da6 (MD5) Previous issue date: 2018-03-12 / The medicine dehumanization has been largely attributed to the medicine schools, which privilege scientific aspects to the detriment of those theoreticians and focus on the humanism. The medicine schools were driven to review their curricula, emphasizing disciplines and organizing interventions for recovering of the humanism in medical practice. The general objective of the dissertation was to identify the actions proposed or developed in medicine courses for resumption of humanization in the medical practice. The specific objectives were to highlight the main attributes of the humanism and to describe the main educational interventions adopted for the humanism development in medical practice. A systematic revision of the literature was carried out for the attainment of the study objectives, by means of researching in the databases of the Latin American and Caribbean Health Sciences Literature and Pub Med, from 2010 to 2016, in Portuguese and English languages. The research resulted in the selection of 23 publications. The results showed that the humanism main attribute is the empathy, which the schools of medicine are developing as main actions the changes in the curriculum of the courses. The main educational implemented actions involve, besides the curricular changes, exchanges and extension programs, through the inclusion of new disciplines, the use of play activities and cultural contexts that are distinct from those of the students' origin. It was concluded that the range of the measures is still small, considering the universe of the medicine courses and its lack of results for more objective analysis. / A “desumanização” da medicina tem sido atribuída em grande parte às escolas de medicina, que privilegiam aspectos científicos, em detrimento daqueles teóricos e voltados ao humanismo. As escolas de medicina se viram impelidas a rever seus currículos, enfatizando disciplinas e organizando intervenções para retomada do humanismo na prática médica. O objetivo geral da dissertação foi identificar as ações propostas ou desenvolvidas nos cursos de medicina para a retomada da humanização na prática médica. Os objetivos específicos foram evidenciar os principais atributos do humanismo e descrever as principais intervenções educacionais adotadas para o desenvolvimento do humanismo na prática médica. Para a consecução dos objetivos do estudo, foi realizada uma revisão sistemática de literatura, mediante pesquisa nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde e PubMed, no período de 2010 a 2016, nos idiomas português e inglês. A pesquisa resultou na seleção de 23 publicações. Os resultados mostraram que o principal atributo do humanismo é a empatia e que as escolas de medicina estão desenvolvendo como principais ações alterações nos currículos dos cursos. As principais ações educacionais implementadas envolvem alterações curriculares, intercâmbios e programas de extensão, mediante a inclusão de novas disciplinas, uso de atividades lúdicas e atuação em contextos culturais distintos dos de origem dos estudantes. Concluiu-se que a abrangência das medidas ainda é pequena, considerando-se o universo dos cursos de medicina, e seus resultados carecem de análise mais objetiva.

The purpose of this study was to investigate pharmacy students’ experiences, perceptions, and beliefs regarding peer-reporting of academic dishonesty by adopting a cross-sectional anonymous survey to pharmacy students in the United States. In addition, this study identified factors that may affect pharmacy students’ likelihood of reporting peers’ academic dishonesty including the relationship between the cheater and their observer, the severity of the punishment on the reported cheating, and the reporting systems. Fifty-six out of 271 respondents (20.7%) reported their engagement of academic dishonesty. One hundred forty-four respondents (53.1%) reported that they directly observed someone else’s cheating behavior. One hundred eighty-nine respondents (69.7%) reported that they indirectly heard about someone else’s cheating behavior from others who directly observed cheating; yet, only 25 respondents (9.2%) peer-reported their classmates’ cheating.The current study shows that although the majority of participants believe that peer-reporting is ethical, they have not reported the cheating they observed due in part to fear of retaliation and no information (or clear direction) on who they should report to or how to report. Additionally, the current study shows that if an innovative system to anonymously report cheating (e.g., a specific peer-reporting website or hotline to protect confidentiality) is adopted, the likelihood to report in the innovative system is higher than in the current system across all types of student-student relationships and all levels of punishment. The current study also demonstrated a statistically significant inverse relationship between likelihood to report and punishment severity. Peer-reporting can be an effective method when well-established polices protect peer-reporters from retaliation and when transparent and reasonable punishments are assigned to those who engage in academic dishonesty. It is imperative that pharmacy schools consider these findings, review their policies regarding academic integrity and its peer-reporting, and modify practices so that professionalism is encouraged and expected.

Medical educators advocate the need for medical students to acquire information management skills, including the ability to search the MEDLINE database. There has been no published validated method available to use for assessing medical students' MEDLINE information retrieval skills. This research proposes and evaluates a method, designed as the MEDLINE Metric, for assessing medical students' search skills. MEDLINE Metric consists of: (a) the development, by experts, of realistic clinical scenarios that include highly constructed search questions designed to test defined search skills; (b) timed tasks (searches) completed by subjects; (c) the evaluation of search results; and (d) instructive feedback. A goal is to offer medical educators a valid, reliable, and feasible way to judge mastery of information searching skill by measuring results (search retrieval) rather than process (search behavior) or cognition (knowledge about searching). Following a documented procedure for test development, search specialists and medical content experts formulated six clinical search scenarios and questions. One hundred and forty-five subjects completed the six-item test under timed conditions. Subjects represented a wide range of MEDLINE search expertise. One hundred twenty complete cases were used, representing 53 second-year medical students (44%), 47 fourth-year medical students (39%), and 20 medical librarians (17%). Data related to educational level, search training, search experience, confidence in retrieval, difficulty of search, and score were analyzed. Evidence supporting the validity of the method includes the agreement by experts about the skills and knowledge necessary to successfully retrieve information relevant to a clinical question from the MEDLINE database. Also, the test discriminated among different performance levels. There were statistically significant, positive relationships between test score and level of education, self-reported previous MEDLINE training, and self-reported previous search experience. The findings from this study suggest that MEDLINE Metric is a valid method for constructing and administering a performance-based test to identify mastery in searching the MEDLINE database. The test's reliability needs to be established.

Healthcare resources are especially limited in rural regions of the US. The lack of Primary Care Providers (PCPs) and mental/behavioral health services is problematic, as there are high rates of behavioral and medical concerns within rural populations. Special populations, such as rural persons with Serious Mental Illness (SMI), are medically complex and represent a vulnerable and underserved population. Healthcare outcomes for persons with SMI are poor compared to the general population and commonly lead to premature death. Various barriers prevent this population from accessing optimal healthcare, especially in rural areas, due to negative perceptions/stigma, a lack of understanding from PCPs, and a shortage of resources in general. The current study aimed to determine the extent of mental health training that rural PCPs receive regarding patients with SMI, as well as to evaluate their perceptions, knowledge, and experiences with these patients and understand providers’ perceptions regarding rates of patients with SMI who present to primary care clinics in rural settings. The current study used a sample of rural primary care providers (N = 90) , surveyed via USPS mail. Results indicated significant differences in reported mental health training among providers from different disciplines. Greater reported mental health training significantly predicted lower levels of stigma, more correctly identified medical conditions comorbid with SMI, and greater reported comfort and confidence in treating patients with SMI. Providers reported differences in the number of patients with and without SMI seen in rural clinics. Implications for these findings are discussed.

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Background: Sweden has a considerable population originating from countries outside of Europe. Many of them are children and adolescents. The knowledge that nurses and medical doctors have of how to assess and treat skin conditions on melanin-rich skin in children and adolescents is, in many cases, insufficient. Aim: The aim was to explore how nurses and medical doctors experience the assessment, treatment and diagnosing of skin conditions in children and adolescents with melanin-rich skin. Method: A qualitative interview study with a semi structured interview guide. Six nurses and five medical doctors from different hospitals and primary care facilities in Uppsala and Malmö participated. Results: The analysis of the participants’ experiences resulted in three different categories: The Care takers feelings of insecurity, Lack of knowledge/experience and Negative Consequences for the child as patient. The participants believed that their lack of knowledge and experience in assessing and treating skin conditions in children and adolescents with melanin-rich skin is due to the fact that this is not taught in nursing and medical training. As a result patients, children and adolescents, are many times made to suffer. Conclusion: Nurses and medical doctors need more knowledge of and experience in how to assess, treat and diagnose children and adolescents with melanin-rich skin. This can be obtained by including training materials at nursing- and medical schools, texts as well as imagery, on how melanin- rich skin looks in its different variations, how it differs from white skin and how it reacts to various conditions. / Bakgrund: Sverige har en betydande befolkning av människor från utomeuropeiska länder. Många av dessa är barn och ungdomar. Kunskapen som sjuksköterskor och läkare har om hur man bedömer och behandlar åkommor på barn och ungdomar med melaninrik hud är i många fall otillräcklig. Syfte: Syftet med studien var att utforska sjuksköterskors och läkares upplevelser av att undersöka, bedöma och diagnosticera hudåkommor hos barn och ungdomar med melaninrik hud.  Metod: Studien genomfördes med en kvalitativ metod där semistrukturerade intervjufrågor användes för att besvara studiens syfte. Sex sjuksköterskor och fem läkare från olika sjukhus och primärvårdsinrättningar i Uppsala och Malmö deltog. Resultat: Deltagarnas upplevelser delades in i tre olika kategorier: Osäkerhet i bemötandet hos vårdgivaren, Saknad av kunskap/erfarenhet samt Negativa konsekvenser för barnet som patient. En majoritet av deltagarna upplevde att deras brist på kunskap och erfarenhet av hur man på bästa sätt bedömer och behandlar barn och ungdomar med melaninrik hud beror på att detta inte tas upp och lärs ut på ett adekvat sätt under deras respektive utbildningar. Resultatet blir i många fall att barnen och ungdomarna som patienter får lida. Slutsats: Sjuksköterskor och läkare behöver mer kunskap och erfarenhet av att bedöma, behandla och diagnosticera barn och ungdomar med melaninrik hud. Detta kan uppnås genom att utbildningar och program för sjuksköterskor och läkare inkluderar utbildningsmaterial i text och bild om hur melaninrik hud skiljer sig från vit hud, hur den, i sina olika variationer, ser ut sig, ter sig och reagerar på skilda åkommor.

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PURPOSE: The purpose of this research was to identify the value of undergraduate nursing student clinical preparation within a dedicated education unit on transition to practice. SPECIFIC AIMS: Describe perceived competence, practice readiness, self-efficacy, job satisfaction, intent-to-stay and orientation length of students who participated in a clinical experience in a dedicated education unit upon graduation, 3- and 6-months employment. Explore new graduate nurses’ perception of the impact of a dedicated education unit clinical experience on transition to practice. Examine relationships between outcome variables. Explore associations between outcome variables and demographic and employment characteristics. FRAMEWORK: This research was guided by Albert Bandura’s Social Learning Theory. DESIGN: This study used a descriptive, longitudinal design with quantitative measures and qualitative interviews. RESULTS: 18 participants provided quantitative data, and five participated in an interview. Competence, practice readiness and job satisfaction were relatively high. Self-efficacy remained essentially unchanged at all three time points. Average orientation length was 13 weeks, with 41.7% reporting their orientation was shorter than planned. At 6-months employment, 91.7% planned to stay in their current position for one year. Competence and Self-efficacy were associated at 3- and 6-months. Prior healthcare work experience was associated with higher competence at 3- and 6-months. Participants valued the experience of working with a preceptor and the supportive learning environment that allowed them to develop technical and professional nursing skills. CONCLUSION: These findings support dedicated education units as having a positive impact on new graduate nurse’s transition to practice.